The contours of the House Republican Medicaid package are becoming clearer — and they’re more likely to be more moderate-friendly now that Speaker Mike Johnson has appeared to rule out two of the more controversial options for reconciliation savings.
Why it matters: Last night’s meeting gave moderates the upper hand, at least for now — but Johnson’s concessions left big questions on how to pay for the massive package.
State of play: Johnson told reporters last night that lowering the federal share of costs in Medicaid, or FMAP, was off the table, and that per capita caps also may be, though he added, “Stay tuned.”
Driving the news: That would leave three main policies that moderates say they could get behind: work requirements, tightening eligibility checks and removing undocumented people from the Medicaid rolls.
- “We just keep bringing the conversation back to those three,” Rep. Juan Ciscomani said last night. “Those are the policies we care about.”
- Ciscomani said that lowering the FMAP was a red line for him because doing so could trigger an Arizona law that would end the state’s Medicaid expansion. He said there was the possibility that per capita caps could do the same, which would also make that a dealbreaker.
Between the lines: The moderate-backed policies would not get to the House’s target of $880 billion in Medicaid savings, so it’s possible that other Medicaid measures will be added, such as limiting provider taxes that help finance the non-federal share of Medicaid spending.
- Restricting provider tax authority would potentially put states in a budget squeeze and could cause coverage losses.
- A CBO estimate requested by Democrats found that fully limiting provider taxes would save $668 billion but lead to 3.9 million people becoming uninsured.
CBO has also told Democrats that work requirements could cause 2.5 million people to become uninsured while saving $260 billion.
- Increasing the frequency of eligibility checks would save $162 billion and lead to 600,000 more uninsured, per CBO.
- Possible ACA marketplace–related changes include funding cost-sharing reduction payments.
Yes, but: A conservative backlash could still force deeper cuts.
- Ciscomani and others said that per capita caps were discussed in the meeting with the speaker, and House Freedom Caucus members are still pushing for more sweeping changes.
- The House Freedom Caucus posted on X in response to Johnson’s remarks that “not addressing ‘FMAP’ is DC talk for continuing the Obamacare policy of discriminating against the people Medicaid is supposed to serve.”
The bottom line: Whatever Medicaid policies are put in the House bill still need to make it through the Senate and gain the approval of President Trump, who has been sticking to his position of wanting to target only “waste, fraud and abuse.”
- Some senators in Medicaid expansion states, including Josh Hawley, have expressed concerns about the per capita caps policy.
- “What we don’t want to do is pass a bill through the House of Representatives that doesn’t even have a shot with the president or the United States Senate,” said Rep. Jeff Van Drew after the meeting last night. “That’s insane. It’s stupid.”
Moderates so far winning Medicaid fight
axios.com
May 7, 2025 1:31 pm
The contours of the House Republican Medicaid package are becoming clearer — and they’re more likely to be more moderate-friendly now that Speaker Mike Johnson has appeared to rule out two of the more controversial options for reconciliation savings.
Why it matters: Last night’s meeting gave moderates the upper hand, at least for now — but Johnson’s concessions left big questions on how to pay for the massive package.
State of play: Johnson told reporters last night that lowering the federal share of costs in Medicaid, or FMAP, was off the table, and that per capita caps also may be, though he added, “Stay tuned.”
Driving the news: That would leave three main policies that moderates say they could get behind: work requirements, tightening eligibility checks and removing undocumented people from the Medicaid rolls.
- “We just keep bringing the conversation back to those three,” Rep. Juan Ciscomani said last night. “Those are the policies we care about.”
- Ciscomani said that lowering the FMAP was a red line for him because doing so could trigger an Arizona law that would end the state’s Medicaid expansion. He said there was the possibility that per capita caps could do the same, which would also make that a dealbreaker.
Between the lines: The moderate-backed policies would not get to the House’s target of $880 billion in Medicaid savings, so it’s possible that other Medicaid measures will be added, such as limiting provider taxes that help finance the non-federal share of Medicaid spending.
- Restricting provider tax authority would potentially put states in a budget squeeze and could cause coverage losses.
- A CBO estimate requested by Democrats found that fully limiting provider taxes would save $668 billion but lead to 3.9 million people becoming uninsured.
CBO has also told Democrats that work requirements could cause 2.5 million people to become uninsured while saving $260 billion.
- Increasing the frequency of eligibility checks would save $162 billion and lead to 600,000 more uninsured, per CBO.
- Possible ACA marketplace–related changes include funding cost-sharing reduction payments.
Yes, but: A conservative backlash could still force deeper cuts.
- Ciscomani and others said that per capita caps were discussed in the meeting with the speaker, and House Freedom Caucus members are still pushing for more sweeping changes.
- The House Freedom Caucus posted on X in response to Johnson’s remarks that “not addressing ‘FMAP’ is DC talk for continuing the Obamacare policy of discriminating against the people Medicaid is supposed to serve.”
The bottom line: Whatever Medicaid policies are put in the House bill still need to make it through the Senate and gain the approval of President Trump, who has been sticking to his position of wanting to target only “waste, fraud and abuse.”
- Some senators in Medicaid expansion states, including Josh Hawley, have expressed concerns about the per capita caps policy.
- “What we don’t want to do is pass a bill through the House of Representatives that doesn’t even have a shot with the president or the United States Senate,” said Rep. Jeff Van Drew after the meeting last night. “That’s insane. It’s stupid.”